Purpose: To investigate the use of intravitreal injection of triamcinolone acetonide (TA) for the treatment of refractory uveitic cystoid macular edema (CME).
Design: Prospective, nonrandomized, self-controlled comparative trial.
Participants: Six patients with chronic CME resistant to treatment with systemic steroids, orbital floor steroids, and cyclosporine A. Three patients were followed for more than 1 year, and the other three for between 3 and 9 months.
Intervention: Injection of 2 mg of TA into the vitreous cavity.
Testing: Optical coherence tomography scanning of the fovea before and after injection and logarithmic minimal angle of resolution visual acuity.
Main outcome measures: Visual acuity, retinal thickness, cystoid space height, and intraocular pressure.
Results: There was complete anatomic resolution of CME in five of the six cases within 1 week after injection. Cystoid spaces began to return between 6 weeks and 3 months after injection. Two patients with longer term follow-up responded to further orbital floor steroid injection and had no CME 1 year later. One patient had raised intraocular pressure develop, requiring a trabeculectomy. Mean improvement in visual acuity after 12 months was 0.27 (range, 0.14-0.42).
Conclusions: Complete anatomic and, to some extent, functional recovery can be induced by intravitreal TA despite long-term refractory inflammatory CME. Optical coherence tomography aids in the management of these cases.